Hemodynamic Consequences of Desmopressin Administration after Cardiopulmonary Bypass

Frankville, David D.; Harper, G B; Lake, Carol L.; Johns, Roger A.

doi:10.1097/00000542-199106000-00004

Cited by 38 publications

(38 citation statements)

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“…We obtained the full text of the remaining 117 records and excluded 33 of them. We divided multi-arm trials into separate trials, which yielded 70 studies with 84 records: 65 completed trials (Aida 1991a; Aida 1991b; Alanay 1999; Andersson 1990; Ansell 1992; Bignami 2016; Brown 1989; Casas 1995; Chuang 1993; Clagett 1995; de Prost 1992; Despotis 1999; Dilthey 1993; Ellis 2001; Flordal 1991; Flordal 1992; Frankville 1991; Gratz 1992; Guay 1992; Guyuron 1996; Hackmann 1989; Hajjar 2007; Hedderich 1990; Hemş inli 2012a; Hemş inli 2012b; Hemş inli 2012c; Horrow 1991a; Horrow 1991b; Horrow 1991c; Jin 2015; Karnezis 1994a; Karnezis 1994b; Kobrinsky 1987; Kuitunen 1992; Lazarchick 1995; Lee 2010; Leino 2010; Lethagen 1991; Letts 1998; Manno 2011; Marczinski 2007; Marquez 1992; Mongan 1992a; Mongan 1992b; Oliver 2000; Ozkisacik 2001; Pleym 2004; Reich 1991; Reynolds 1993; Rocha 1988; Rocha 1994; Salmenpera 1991; Salzman 1986; Schott 1995; Seear 1989; Shao 2015; Sheridan 1994; Spyt 1990; Steinlechner 2011; Temeck 1994; Theroux 1997; Wingate 1992a; Wingate 1992b; Wong 2003; Zohar 2001); four ongoing trials (ISRCTN12845429; NCT00885924; NCT01982760; NCT02084342); and one trial awaiting classification (Jahangirifard 2017).…”

Section: Resultsmentioning

confidence: 99%

Desmopressin use for minimising perioperative blood transfusion

Desborough

Oakland

Brierley

et al. 2017

Cochrane Database of Systematic Reviews

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Background Blood transfusion is administered during many types of surgery, but its efficacy and safety are increasingly questioned. Evaluation of the efficacy of agents, such as desmopressin (DDAVP; 1-deamino-8-D-arginine-vasopressin), that may reduce perioperative blood loss is needed. Objectives To examine the evidence for the efficacy of DDAVP in reducing perioperative blood loss and the need for red cell transfusion in people who do not have inherited bleeding disorders. Search methods We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (2017, issue 3) in the Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (from 1937), the Transfusion Evidence Library (from 1980), and ongoing trial databases (all searches to 3 April 2017). Selection criteria We included randomised controlled trials comparing DDAVP to placebo or an active comparator (e.g. tranexamic acid, aprotinin) before, during, or immediately after surgery or after invasive procedures in adults or children. Data collection and analysis We used the standard methodological procedures expected by Cochrane. Main results We identified 65 completed trials (3874 participants) and four ongoing trials. Of the 65 completed trials, 39 focused on adult cardiac surgery, three on paediatric cardiac surgery, 12 on orthopaedic surgery, two on plastic surgery, and two on vascular surgery; seven studies were conducted in surgery for other conditions. These trials were conducted between 1986 and 2016, and 11 were funded by pharmaceutical companies or by a party with a commercial interest in the outcome of the trial. The GRADE quality of evidence was very low to moderate across all outcomes. No trial reported quality of life. DDAVP versus placebo or no treatment Trial results showed considerable heterogeneity between surgical settings for total volume of red cells transfused (low-quality evidence) and for total blood loss (very low-quality evidence) due to large differences in baseline blood loss. Consequently, these outcomes were not pooled and were reported in subgroups. Compared with placebo, DDAVP may slightly decrease the total volume of red cells transfused in adult cardiac surgery (mean difference (MD) -0.52 units, 95% confidence interval (CI) -0.96 to -0.08 units; 14 trials, 957 participants), but may lead to little or no difference in orthopaedic surgery (MD -0.02, 95% CI -0.67 to 0.64 units; 6 trials, 303 participants), vascular surgery (MD 0.06, 95% CI -0.60 to 0.73 units; 2 trials, 135 participants), or hepatic surgery (MD -0.47, 95% CI -1.27 to 0.33 units; 1 trial, 59 participants). DDAVP probably leads to little or no difference in the total number of participants transfused with blood (risk ratio (RR) 0.96, 95% CI 0.86 to 1.06; 25 trials; 1806 participants) (moderate-quality evidence). Whether DDAVP decreases total blood loss in adult cardiac surgery (MD -135.24 mL, 95% CI -210.80 mL to -59.68 mL; 22 trials, 1358 pa...

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Section: Resultsmentioning

confidence: 99%

Desmopressin use for minimising perioperative blood transfusion

Desborough

Oakland

Brierley

et al. 2017

Cochrane Database of Systematic Reviews

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“…Of these 142 trials, 95 were apparently randomized, controlled studies. Nine studies were excluded because no clinical outcome other than blood loss was available, [7][8][9][10][11][12][13][14][15] eight studies were found not to be randomized after more thorough analysis, [16][17][18][19][20][21][22][23] five studies concerned cardiac surgery in child- ren, [24][25][26][27][28] and there was one double report. 29,36 66,75,[86][87][88][89][90][91][92][93][94][95][96][97][98][99] In addition, 12 studies compared treatment with the conventional dose of aprotinin with lower doses of aprotinin.…”

Section: Literature Search and Methodological Gradingmentioning

confidence: 99%

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

Levi¹,

Cromheecke²,

Jonge³

et al. 2001

Transfus Alt Transfus Med

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SUMMARY Background: Excessive bleeding may complicate cardiac surgery, and is associated with increased morbidity and mortality. Pharmacological strategies to decrease perioperative bleeding have been investigated in a large number of controlled trials, most of which have shown a decrease in blood loss. However, most studies lacked sufficient power to detect a beneficial effect on clinically more relevant outcomes. We did a meta‐analysis of all randomized, controlled trials of the three most frequently used pharmacological strategies to decrease perioperative blood loss (aprotinin, lysine analogues [aminocaproic acid and tranexamic acid], and desmopressin). Methods: Studies were included if they reported at least one clinically relevant outcome (mortality, rethoracotomy, proportion of patients receiving a transfusion, or perioperative myocardial infarction) in addition to perioperative blood loss. In addition, a separate meta‐analysis was done for studies concerning complicated cardiac surgery. Findings: We identified 72 trials (8409 patients) that met the inclusion criteria. Treatment with aprotinin decreased mortality almost two‐fold (odds ratio 0.55 [95% CI 0.34‐0.90]) compared with placebo. Treatment with aprotinin and with lysine analogues decreased the frequency of surgical re‐exploration (0.37 [0.25‐0.55], and 0.44 [0.22‐0.90], respectively). These two treatments also significantly decreased the proportion of patients receiving any allogeneic blood transfusion. By contrast, the use of desmopressin resulted in a small decrease in perioperative blood loss, but was not associated with a beneficial effect on other clinical outcomes. Aprotinin and lysine analogues did not increase the risk of perioperative myocardial infarction; however, desmopressin was associated with a 2.4‐fold increase in the risk of this complication. Studies in patients undergoing complicated cardiac surgery showed similar results. Interpretation: Pharmacological strategies that decrease perioperative blood loss in cardiac surgery, in particular aprotinin and lysine analogues, also decrease mortality, the need for rethoracotomy, and the proportion of patients receiving a blood transfusion.

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“…29 Desmopressin should be administered by slow intravenous infusion at a dose of 0.3 µg/kg to avoid hypotension. 30,31 An initial study reported that DDAVP reduced blood loss and transfusion needs by around 30% during complex cardiac surgery. [32][33][34] Later attempts to reproduce these findings were variable; most did not confirm the marked benefit originally reported.…”

Section: Desmopressin (Ddavp)mentioning

confidence: 99%

Prohemostatic Treatment in Cardiac Surgery

Levy

Sniecinski

2012

Semin Thromb Hemost

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Cardiac surgical patients represent a unique group of patients where coagulopathy occurs due to multiple causes besides simple hemorrhagic blood loss. Hemodilution, inflammation, and hemostatic activation while on cardiopulmonary bypass all contribute to this problem and provide targets for therapeutic intervention. Current pharmacological strategies to reduce the need for allogeneic transfusions include both preemptive agents to decrease the potential for bleeding as well as prohemostatic agents to promote the coagulation process. This article will discuss pharmacological agents including antifibrinolytics, protamine, desmopressin, fibrinogen, purified protein concentrates, recombinant factor VIIa, factor XIII, and topical agents used in cardiac surgery.

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Hemodynamic Consequences of Desmopressin Administration after Cardiopulmonary Bypass

Cited by 38 publications

References 0 publications

Desmopressin use for minimising perioperative blood transfusion

Desmopressin use for minimising perioperative blood transfusion

Pharmacological Strategies to Decrease Excessive Blood Loss in Cardiac Surgery: Meta‐analysis of Clinically Relevant Endpoints*

Prohemostatic Treatment in Cardiac Surgery

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